Epiglottitis In Children Research Articles

Supraglottitis: An airway emergency

Supraglottitis is a life-threatening condition and refers to inflammation of the epiglottis and the surrounding supraglottic structures. Children usually present with only a swollen epiglottis, termed epiglottitis. Fortunately, the incidence of epiglottitis in children has declined following routine Haemophilus influenzae type B vaccination, but the incidence in adults has increased. Supraglottitis has a high morbidity and mortality from the associated risk of airway obstruction. Therefore, early recognition and urgent secondary care referral is paramount. However, the presentation of this condition can be subtle and differs between children and adults; this can lead to difficulties in diagnosis. This article will review the clinical presentation and management of supraglottitis, an important differential for acute sore throat and hoarse voice.

Pediatric thermal epiglottitis: insights from a tertiary center experience.

Thermal epiglottitis, a non-infectious cause of epiglottitis, is a rare entity that shares some clinical features with infectious epiglottitis. This study presents 16 years of experience in diagnosing and managing thermal epiglottitis. A retrospective descriptive study in a tertiary center in southern Israel included confirmed cases of thermal epiglottitis in children (0-18 years) between 2004 and 2020 by endoscopy. Of approximately 600,000 pediatric ER admissions between 2004 and 2020, seven children were diagnosed by endoscopy with thermal epiglottitis (mean age 24 months, 71% males). Clinical presentation included stridor, respiratory distress, and drooling. Four children had fever and elevated inflammatory markers at presentation and were treated with systemic antibiotics. All were treated with systemic steroids. The median length of stay in the PICU was five days, and four patients required intubations. All fully recovered without experiencing any sequelae. Conclusion: Thermal epiglottitis stands as a potential contributor to acute upper airway obstruction. Although it's rarity, it should be discussed in any child with acute upper airway obstruction. It is essential to inquire directly about the accidental intake of hot beverages, particularly in cases lacking fever or elevated inflammatory markers. What is Known: • Thermal epiglottitis is a rare, non-infectious condition sharing clinical features with infectious epiglottitis. • Common presentations include stridor, respiratory distress, and drooling. What is New: • Thermal epiglottitis is a potential contributor to acute upper airway obstruction, urging consideration even in the absence of fever or elevated markers. • Direct inquiry about hot beverage intake for diagnosis is essential for diagnosis.

The modern view on the epiglottitis treatment

Primary health care is defined as “primary contact, continuous, comprehensive, and coordinated care provided to the population without differentiation by gender, disease, or organ system”. Versatility, as part of medical school curricula, is intrinsically important for those pursuing careers with a significant primary care component, such as family medicine, emergency medicine, therapy, and pediatrics. Otolaryngology is an important specialty related to family medicine, pediatrics, and general practice. Otolaryngological problems make up a significant part of appeals for primary health care. Approximately 20 to 40 % of adult general practice consultations are related to otolaryngological complaints. The Ukrainian health care reform makes significant adjustments in approaches to the diagnosis and treatment of most diseases. Pathology can be so varied and the scope of practical skills can be limited by doctor’s competence. For diagnosis, a family doctor can use the ISPS-2 international classification, which greatly facilitates and unifies the work of a general practitioner. An epiglottic abscess is usually the final stage of inflammation of the epiglottis (epiglottitis) and surrounding tissues. The etiology of the disease can be of infectious or non-infectious nature. Clinical signs of epiglottitis vary depending on age, severity, and etiology. Without treatment, epiglottitis can progress to life-threatening airway obstruction, so prompt diag­nosis and management of epiglottitis in children is extremely important. The disease must be diagnosed at the early stages of the pathological process, following the patient’s route. It requires deep knowledge of the disease etiopathogenesis, mastering research methods, and using all the possible arsenal of treatment to prevent complications. Coordinated cooperation of medical staff at all stages of providing medical care should be ensured.

Clinical and laboratory characteristics of epiglottitis caused by Haemophilus influenzae type b in children

BACKGROUND: Epiglottitis is an acute infectious disease accompanied by edema of the epiglottis, salivation, sore throat, and intoxication. In 95% of cases, the causative agent of epiglottitis in children is Haemophilus nfluenza type b (Hib). The relevance of the problem is that acute epiglottitis of Haemophilus etiology is not a localized, isolated disease of the ENT organs, but can result in development of an epiglottic abscess or phlegmon, as well as of other generalized forms of Hib infection, including sepsis.
 AIM: The aim of the study was to assess the incidence of epiglottitis caused by Hib in children and provide its clinical and laboratory characteristics.
 MATERIALS AND METHODS: We analyzed 23 cases of epiglottitis caused by Hib in children. The diagnosis was based on clinical and epidemiological data with mandatory verification by bacteriological, serological, and/or molecular biological methods.
 RESULTS: Epiglottitis was detected in 23 of 93 children with Hib infection who were treated at the Childrens Municipal Clinical Hospital No. 5 named after N.F. Filatov over the period from 2002 to 2016. Hib etiology of epiglottitis was confirmed mainly by the bacteriological method. All patients were prescribed ceftriaxone, which is the drug of choice for suspected Hib infection. Monotherapy was prescribed in 57% cases; two or more antibiotics were used in other cases (a course of 714 days).
 CONCLUSIONS: Epiglottitis is a severe, life-threatening disorder being a generalized Hib infection. Patients with epiglottitis should be prescribed antibiotics prior to confirmation of Hib etiology since Hib is the causative agent of epiglottitis in the vast majority of pediatric cases. Multiple methods should be used simultaneously to confirm the diagnosis. Bacteriological blood test made it possible to identify the pathogen in the overwhelming majority of patients. There were no risk factors for Hib infection and no important comorbidity.

Acute Adult Supraglottitis: An Impending Threat to Patency of Airway and Life.

IntroductionAcute adult supraglottitis (AAS) is one of the upper airway infections that can potentially cause upper airway obstruction and, if not treated promptly, can be life-threatening. The widespread use of vaccines against Hemophilus influenzae has decreased the incidence of epiglottitis in children, whereas the incidence of AAS is on the rise. We aim to highlight the presentation, diagnosis, and management in AAS with our study. Patients and MethodsA retrospective analysis was performed on all patients admitted to a tertiary health care facility surgical intensive care unit (SICU) where AAS was identified and the demographic data, duration of symptoms, imaging studies, management, and complications were recorded. In these patients, the diagnosis of AAS was confirmed by nasopharyngeal endoscopy. Data was entered in the IBM Statistical Package for Social Sciences (SPSS), version 23 (IBM SPSS Statistics, Armonk, NY), and groups were compared using student t-test and chi-square test. P values of ≤ 0.05 were considered statistically significant.ResultsA total of 118 patients were admitted to the SICU. The male: female ratio was 3.9: 1. Major risk factors were smoking and drinking cold liquids. The common presenting symptom was sore throat (89.8%). The thumb sign was positive in 65% of the patients. Common bacteria were the Streptococcus species (11.9%). Ceftriaxone was the most commonly prescribed inpatient antibiotic. All patients received steroids as adjuvant therapy. Adrenaline nebulization was used in 66% of the cases. Forty-six percent of patients required endotracheal intubation. In 10.2% of patients, intubation was not possible and in 12.7% of patients, a tracheostomy was done. Ludwig’s angina was the most frequent complication. Patients presenting with dysphagia and fever had a significantly higher incidence of Ludwig’s angina (P ≤ 0.02 and 0.005, respectively). AAS patients complicating into Ludwig’s angina (severe cellulitis of submandibular, submental, and sublingual spaces) had a significantly longer duration of symptoms, a higher incidence of streptococcal infection, airway interventions, and prolonged stay in an intensive care unit (p ≤ 0.05).ConclusionMale gender, smoking, and drinking cold liquids were the risk factors associated with AAS, and thumb sign on lateral neck soft tissue x-ray was suggestive of it. AAS caused by Streptococcus species was a relatively serious condition, leading to complications like Ludwig’s angina.

Acute epiglottitis in a fully immunized child

Acute epiglottitis in children became a rare entity after introduction of the conjugate Haemophilus influenzae type b(Hib) vaccine1.However, physicians must be aware that epiglottitis may result from vaccine failures or from infection with other pathogenic organisms. Vaccinated children with epiglottitis present in a similar fashion to those who are not vaccinated2. The following is a case of a previously healthy and immunized child who presented to paediatric ward and ultimately diagnosed as epiglottitis.

Neisseria meningitidis Causing Acute Epiglottitis in an Adult

Abstract With the advent of vaccine against Haemophilus influenzae serotype B, acute epiglottitis in children has significantly decreased in the past several decades. As a result, now most cases of acute epiglottitis occur in adult population. Neisseria meningitidis epiglottitis is rare in humans. We report a case of acute epiglottitis caused by N. meningitidis in an 82-year-old patient from East Sussex Healthcare Trust, United Kingdom. This patient presented to our emergency department with odynophagia, sore throat, pyrexia, and respiratory distress. Examination revealed severe swelling in the epiglottis and surrounding areas. The airway was secured rapidly by intubation. Blood culture yielded N. meningitidis serotype W135. The patient was treated with appropriate antibiotics and discharged well. All contacts and the health care personnel who were involved in the management of this patient, who met with the prophylaxis criteria, received chemoprophylaxis. This patient was similar to those previously reported (11 cases) in the literature in terms of the following: (a) clinical presentation, (b) intubation to secure airway, (c) responding well to the antimicrobial therapy, (d) received steroids, and (e) discharged well. We also describe the epidemiological features of 11 patients with acute epiglottitis caused by N. meningitidis.

EPIGLOTTIS MICROFLORA OF ADULT PATIENTS WITH ACUTE EPIGLOTTITIS

Introduction. Nowadays acute infectious-inflammatory processes of upper respiratory tract, including acute epiglottitis retain a high proportion among human pathology. In the literature acute epiglottitis is allocated into an independent nosology as severe acute phlegmonous bacterial inflammation of the epiglottis and hypopharynx. There are currently no clear guidelines on how to classify an acute epiglottitis, as well as protocols for patients at various stages of the pathological process. According to common belief, Haemophilus influenzae type -B (Haemophilus influenza type b (Hib)) is the most common cause of epiglottitis. At present, the main etiological role in the genesis of acute epiglottitis in children belongs to haemophilus influenzae. In adults the causes of the disease are beta hemolytic streptococci groups A, B, pneumococcus, Klebsiella, Pseudomonas, Staphylococcus aureus, herpes simplex virus (type 1) and parainfluenza, and others.The aim of this work is to study: the mucosal microflora of the epiglottis in adult patients with acute epiglottitis and to study sensitivity of certain isolates to antimicrobial agents. Material & methods. 86 adult patients with acute epiglottitis were observed: 36 with abscess form of epiglottitis and 50 - with infiltrative. Microbiological analysis of mucosal swab samples taken from hypopharynx were conducted by the conventional technology: for seeding solid or liquid nutrient medium, followed by allocation of isolith and its microscopic, biochemical and serological identification. Microorganisms were classified according to schemes of Bergy. Antimicrobial susceptibility of each strain was determined in accordance with the guidelines. We used discs with antibacterial drugs. The availability of sensitive and resistant strains of microorganisms to antibiotics was assessed. A mucous membrane of the epiglottis was analyzed through microbiological investigation in 86 patients with acute epiglottitis. As a result, 169 strains of microorganisms were sowed from mucous membrane of epiglottis. Results & discussion. In patients with acute epiglottitis Streptococcus progenies dominated in 33 (23.7%) of cases, H. influenza was detected in 27 cases (19.4%), Streptococcus pneumonia strain was in 21 (12.4%) of cases, 4th place -. Staphylococcus aureus -9.3%. There are different types of: staphylococci strains -29, of Enterococcus spp - 11, gram-negative bacilli -41. Noteworthy fact is the high degree of microbial contamination of patients 107-109 CFU. Conclusion. Acute epiglottitis highest sensitivity was observed to the following medications as cephalosporin, namely cefotaxime while it is variable within the same group (1,2,3 cephalosporin’s generation). The isolated strains showed almost 99,4±1,2% sensitivity to fluoroquinolones, especially to levofloxacin and others (S. aureus, S. pyogenes, S. pneumoniae, H. Influenzae). There was a high sensitivity to lincosamides - clindamycin; fluoroquinolones- levofloxacin. In 50% of cases, a resistance to the antibiotic penicillin; and macrolide antibiotic, especially the last generations was observed. According to the obtained findings on the sensitivity of microflora to antibiotics cephalosporin’s II- III generation with moderate and severe degrees of severity in combination with fluoroquinolones (all administered parenterally) are used in acute epiglottitis. Use of fluoroquinolones (levofloxacin, ciprofloxacin, and others) is recommended in case of Cephalosporin intolerance, as well as lincosamides (clindamycin, dalatsin, lincomycin)

Acute Epiglottitis in a 79‐Year‐Old Man

Acute Epiglottitis in a 79‐Year‐Old Man

The burden of epiglottitis among Japanese children before the Haemophilus influenzae type b vaccination era: an analysis using a nationwide administrative database

Epiglottitis is a potentially life-threatening disease and is largely preventable by vaccination against Haemophilus influenzae type b (Hib). Little is known, however, about the epidemiology of childhood epiglottitis in Asian countries, including Japan. Using a nationwide inpatient database, this study aimed to determine the burden of childhood epiglottitis before the introduction of Hib vaccine into Japan. The study period was between July and December in 2007 and 2008, when Hib vaccine was not available. We found 102 cases with epiglottitis among children ≤5 years old. The annual incidence of epiglottitis in children ≤5 years old was estimated to be 3.2 per 100,000 population per year. Among the 102 patients, 31 (30.4%) required respiratory support, including two cases with tracheotomy and one fatal case. Our study demonstrated the substantial burden of epiglottitis among Japanese children, highlighting that a routine Hib vaccination program is essential.

Acute supraglottitis in adults in Finland: Review and analysis of 308 cases

The aim of this article is to study the clinical features, management, and outcome in adult patients with acute supraglottitis. Retrospective review. We searched the medical records from our database from the years 1989 to 2009 using codes of international statistical classification of diseases and related health problems for acute epiglottitis or supraglottitis. In total, 308 patients were identified. Incidence of acute supraglottitis increased from 1.88 (first decade) to 4.73 per 100,000 cases (second decade) (P = .05). The mean age of the patients was 49 years old with a slightly male predominance. Sore throat and odynophagia were the most common symptoms. Concomitant disease were common among the patients. Isolated inflammation of epiglottis without involvement of other supraglottic tissue was detected only in 51 patients. Intravenous cephalosporins were the most common empiric antibiotic treatment regimen. Intravenous corticosteroids were administered to half of the cases. Streptococcus was the most common organism in throat cultures. In total, 45 patients needed airway intervention. Complications were rare and mortality was 0.6% in our series. Acute supraglottitis in adults seems to be a different entity than epiglottitis in children, and inflammation does not usually exclusively involve the epiglottis. Early diagnosis seems to decrease the need for airway intervention and to permit the successful treatment of the patient with intravenous antibiotics and corticosteroids. Streptococcus appears as the dominant causative microorganism. However systemic diseases and other local infections that compromise the regional supraglottic immunity may increase the risk for acute supraglottitis.

Two Cases of Acute Epiglottitis in Children Treated with Airway Control

Acute epiglottitis can produce airway obstruction, so we must usually treat these patients immediately with airway control. In Japan, acute epiglottitis in adults is common, but acute epiglottitis in children is very rare. In this paper, 2 cases of acute epiglottitis in children are reported. One patient was a 3-year-old boy. He visited our hospital complaining of dyspnea, trouble with speaking and stridor. Fiberscope examination of the larynx revealed severe swollen epiglottis, so we diagnosed acute epiglottitis. We immediately performed a tracheotomy to maintain the airway. After 5 days, the swollen epiglottis had improved and the patient recovered completely within 10 days. We detected Haemophilus influenzae from the blood cultures. The other patient was a 2-year-old girl. She visited our hospital complaining of dyspnea and stridor. Fiberscope examination of the larynx revealed a moderately swollen epiglottis, so we diagnosed acute epiglottitis. We immediately performed tracheal intubation to maintain the airway. The next day, the swollen epiglottis had improved and she recovered completely within 10 days. We detected Haemophilus influenzae from the blood cultures. We describe the diagnosis and treatment of acute epigolottitis in children, especially with regard to airway control.

Epiglottitis due to nontypeable Haemophilus influenzae in a vaccinated child

Once a prevalent disease, acute epiglottitis in children has become a rare entity. The introduction of the Haemophilus influenzae type b vaccine has had a dramatic impact on the number of invasive infections caused by this organism. However, physicians must be aware that epiglottitis may result from vaccine failures or from infection with other pathogenic organisms. Vaccinated children with epiglottitis present in a similar fashion to those who are not vaccinated. We present a rare case of acute epiglottitis in a fully vaccinated child due to nontypeable H. influenzae and discuss the clinical presentation and management.

Necrotizing epiglottitis and hemophagocytic lymphohistiocytosis

With the introduction of vaccination for haemophilus influenza, the epidemiology of epiglottitis in children has changed. Classic childhood epiglottitis is now rare, and unusual forms of the disease may be seen. Nectrotizing epiglottitis is an extremely rare form of epiglottitis. Only four cases of nectrotizing epiglottitis have been previously reported, and all cases were in immunocompromised adult patients. Hemophagocytic lymphohistiocytosis is a rare condition characterized by high fevers, hepatosplenomegaly, and cytopenias caused by an abnormal proliferation and activation of macrophages. We report the first case of a previously healthy 5-year-old male presenting with acute onset of airway distress and pancytopenia. Subsequent airway evaluation led to the diagnosis of nectrotizing epiglottitis, and he was simultaneously diagnosed with infection-induced hemophagocytic lymphohistiocytosis. The patient recovered with intubation and antibiotics. Follow-up direct laryngoscopy revealed an epiglottis remnant with approximately 50% loss of epiglottic tissue. The presentation and pathophysiology of this unusual manifestation of epiglottitis and hemophagocytic lymphohistiocytosis will be reviewed. In the post-haemophilus influenze vaccination era, the pediatric otolaryngologist must be familiar with unusual forms of epiglottitis and its associated manifestations.

Acute epiglottitis: epidemiology, clinical presentation, management and outcome

To describe the incidence trends, clinical presentation, management and outcome of acute epiglottitis in a Danish population after the introduction of Haemophilus influenzae type b vaccine. Retrospective review of the health records of all patients discharged with a diagnosis of acute epiglottitis from the otolaryngology department, Roskilde County Hospital, Denmark, from 1996 to 2005. One infant and 34 adults were identified. The incidence of acute epiglottitis in children was 0.02 cases/100,000/year. Before introduction of the H influenzae type b vaccination (1983-1992), the mean national incidence of acute epiglottitis was 4.9 cases/100,000/year. The incidence of acute epiglottitis in adults was constant, with a mean value of 1.9 cases/100,000/year. Twenty-nine per cent of the patients required an artificial airway, and respiratory distress was found to be associated with airway intervention (p = 0.010). All patients recovered completely. In the H influenzae type b vaccine era, acute epiglottitis in children has almost disappeared. The incidence in the adult population has been constant. A discriminate approach to airway management seems safe in adults.

Changes in the epidemiology of epiglottitis following introduction of Haemophilus influenzae type b (Hib) conjugate vaccines in England: a comparison of two data sources

Paediatric cases of epiglottitis declined markedly in England following the introduction of safe effective immunization against Haemophilus influenzae type b (Hib). With the recently described resurgence in Hib infections, a corresponding rise in the number of presentations of clinical epiglottitis in children was observed, although numbers were still well below those reported prior to vaccine availability. This was seen both in microbiology reports and hospital admissions data for England. In keeping with the more diverse aetiology of epiglottitis in adults, Hib vaccination had minimal impact on hospital presentations with upper airway infections in those aged 15 years and over, which showed an overall increasing trend over 10 years. The need for a high index of suspicion to allow early diagnosis of this life-threatening clinical presentation is reinforced.

Non-infectious epiglottitis in children: Two cases report

Two young children who suffered from thermal injuries to the epiglottis after swallowing corrosive agent and hot water respectively. Findings, clinically and radiologically, in both children were similar to acute infectious epiglottitis. Both recovered quickly with close observation and parenteral antibiotics. Although Haemophilus influenzae typeb (Hib) is the major pathogen of epiglottitis, in areas with low incidence of Hib infection and high vaccination rates, non-infectious epiglottic swelling should be considered first.

Paediatric epiglottitis: the influence of the Haemophilus influenzae b vaccine, a ten-year review in the Sheffield region.

Cases of acute epiglottitis in children have become very uncommon in recent years. This study set out to find whether the introduction of the Haemophilus influenzae b (Hib) vaccine in the UK in October 1992 has influenced the incidence of acute epiglottitis in the Sheffield region, and whether the pathogenesis has altered. A 10-year retrospective case note review was undertaken. A total of 30 children were treated for acute epiglottitis in Sheffield Children's Hospital over that time period. A sharp decline in the number of cases was found after the vaccine was introduced. Most children presenting with the disease after October 1992 had not been vaccinated. In addition, the pathogens isolated in those children who had received the vaccine were all Streptococci. This is the first study in the UK to examine the influence of the Hib vaccine on acute paediatric epiglottitis.

Adult acute epiglottitis caused by Serratia marcescens

Acute epiglottitis has historically been a common disease in the pediatric population, with relatively few adult cases reported. Because of the introduction of the Haemophilus influenzae vaccine in the recent past, acute epiglottitis in children has become uncommon. In contrast, an increasing number of cases of epiglottitis in adults have been described.1 Although the incidence in children has declined from 3.5 cases per 100,000 population per year to 0.6 cases per 100,000 per year, the adult incidence has remained relatively stable at 1.8 cases per 100,000. As in children, adult epiglottitis is manifest by dysphagia, odynophagia, and occasionally stridor progressing to airway obstruction. Although in the pediatric patients H. influenzae is the most common causative agent, the majority of adults are not culture positive for a specific pathogen.1,2 Also, in adults, a variety of infectious agents have been identified, including pneumonococcal species and Candida, especially in immunocompromised patients.3,4 However, to date, no cases of Serratia marcescens epiglottitis have been described. This article reports two adult immunocompromised patients with well–documented S. marcescens epiglottitis. A review of the presentation and treatment of adult patients with epiglottitis is included.

Incidence, aetiology, and prognosis of acute epiglottitis in children and adults in Sweden.

A retrospective study of the incidence, aetiology and case fatality rate of acute epiglottitis in children and adults was performed. The study covered the whole of Sweden (population 8.4 million) during the years 1987-89, before general vaccination against Haemophilus influenzae (Hi) type b was started. Patients were included if it was documented that they fulfilled all 3 of the following criteria: (a) red and swollen epiglottis visualized by indirect laryngoscopy, (b) inspiratory stridor or difficulties in swallowing, and (c) a temperature > or = 38 degrees C. A total of 306 children and adolescents (0-19 years) and 502 adults (> or = 20 years) were found. The age-specific incidence was highest in children aged 0-4 years, (14.7/100,000 per year). The total incidence was 3.2/100,000 per year. In the age group 0-19 years, blood cultures had been obtained from 195 (64%) and Hi was isolated from 154 (79%). In adults (> or = 20 years), 114 of 298 blood cultures yielded Hi, while pneumococci were isolated from 5 and group A streptococci from 3 patients. A total of 220 children (72%) and 114 adults (23%) needed an artificial airway. Five children and 12 adults died. In conclusion, the incidence of acute epiglottis in Sweden is very high. Compared to a previous country-wide study covering the years 1981-83 that used the same methods for case finding and case definition, the incidence in children had decreased while the incidence in adults had increased.